Jordan

Background

Since 2009, two projects have been conducted in Jordan with funding from the US Agency for International Development (USAID) through the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program and its predecessor, the Strengthening Pharmaceutical Systems (SPS) Program, both implemented by Management Sciences for Health.

The Jordan Food and Drug Administration (JFDA) conducted a study in May 2009 on surgical antibiotic prophylaxis practices in Jordanian hospitals, including for cesarean section (CS). Based on the findings of the study, SPS and later SIAPS provided technical assistance to help strengthen practices regarding antibiotic prophylaxis for CSs at three Ministry of Health (MOH) hospitals in Jordan—Prince Hussein Hospital, Prince Faisal Hospital, and Dr. Jameel Al Totanji Hospital.

In 2016 and 2017, USAID’s Office of US Foreign Disaster Assistance (OFDA) funded SIAPS to develop training materials and facilitate training of humanitarian aid partners and local and international nongovernment organizations to ensure efficient procurement and supply chain management for quality-assured pharmaceuticals and medical commodities to conflict-affected, internally displaced people.

Methodology

For the antibiotic prophylaxis project, the three hospitals developed several tools to support a system redesign for antibiotic prophylaxis use and a customized protocol and procedures for assessing prophylactic use of antibiotics post-CS. To monitor the use of antibiotics using patient CS logs and an Excel monitoring tool, key indicators were developed and agreed to, including adherence to protocol for the recommended antibiotic, time of administration of first dose of prophylactic antibiotic, rate of surgical site infections, and cost savings.

For the training program, SIAPS used the needs assessment survey results to develop training materials relating to emergency/humanitarian response supply chain management and used those materials to facilitate the training, which was attended by participants based in Iraq, Jordan, Syria, Turkey, Palestine, and Yemen. Participants were field personnel working in the Middle East who are routinely involved in managing pharmaceuticals and medical commodities supported by USAID/OFDA.

Results

For the antibiotic prophylaxis project, the hospitals used the customized protocols and procedures to gradually establish a CQI-like system and achieve high levels of adherence to protocols and procedures in terms of the use of the antibiotic of choice (cefazolin), the use of a single dose, and the administration of the antibiotic prior to skin incision. The use of the new protocols resulted in substantial cost savings when compared with the cost of antibiotics during the baseline period. The site infection rate was 1.59%, and following the intervention, 81% (2,303) of cases had a CS log filled, 86% had the correct prophylactic antibiotic prescribed, 92% had the first dose given at the correct time, and 88% had the correct number of antibiotics administered. Through these efforts, the average cost of antibiotic prophylaxis decreased from 5.98 Jordanian Dinar (JD) to 1.245 JD, a 79% decrease by 2012.

During the training program, 49 participants (33 male, 16 female) from 16 organizations were trained, including the International Medical Corps, International Rescue Committee, Relief International, Care International, International Organization for Migration, Medair, Première Urgence Internationale, Syria Relief and Development Foundation, Syrian American Medical Society, United Nations Population Fund, United Nations Children’s Fund, World Health Organization, World Vision International, International Federation of the Red Cross and Red Crescent Societies, Food and Agriculture Organization of the United Nations, and World Relief Germany.

The Way Forward

Evidence-based and standardized care for mothers undergoing CS

Support for AMR containment through judiciousness and stewardship in the use of antibiotics for prophylaxis in surgery

Improved pharmaceutical care

Support to USAID/OFDA partner organizations to develop a humanitarian supply chain strategy and guidelines for responding to disasters based on the four phases of disaster management.